布托啡诺预先给药对大鼠心肌缺血再灌注损伤的影响

Objective To investigate the effects of butorphanol pretreatment on myocardial ischemia-reperfusion (IR) injury in rats. Methods Forty healthy male SD rats weighing 200-250 g were randomly divided into 5 groups (n = 8 each) : sham operation group (group S); IR group; butorphanol pretreatment group (group B); Nor-BNI group (group N) and glibenclamide group (group G) . In group IR, B, N and G, myocardial IR was produced by occlusion of left anterior descending artery (LAD) for 30 min followed by 120 min reperfusion. In group S and IR, normal saline S ml/kg was injected via femoral vein 10 min before ischemia and then continuously infused at a rate of 5 ml· kg -1· h-1 iv. In group B, butorphanol 25 μg/kg was injected via femoral vein 10 min before ischemia and the rest method was the same as that described in group IR. In group N, Nor-BNI 2 mg/kg (a selective κ-opioid receptor antagonist) was injected via femoral vein 20 min before ischemia and the rest method was the same as that described in group B. In group G, glibenclamide 1 mg/kg (a KATP channel blocker) was injected via femoral vein 10 min before ischemia and the rest method was the same as that described in group B. Blood samples were taken from femoral artery at 120 min of reperfusion for determination of the concentrations of serum TNF-α, IL-6 and IL-10 by ELISA. Myocardial infarct area and ischemic area were measured by TTC staining and myocardial infarct size was calculated. Results The concentrations of serum TNF-a, IL-6 and IL-10 were significantly higher in the other four groups than in group S (P < 0.05) . The concentrations of serum TNF-α andIL-6 were significantly decreased while IL-10 increased, and the myocardial infarct size was significantly decreased in group B, N and G as compared with group IR ( P < 0.05) . The concentrations of serum TNF-α and IL-6 were significantly increased while the concentration of IL-10 decreased) and the myocardial infarct size was significantly increased in group N and G as compared with group B ( P < 0.05). Conclusion Butorphanol pretreatment can protect the myocardium against IR injury in rate via activating κ receptor and KATP channel.     

布托啡诺预先给药对大鼠心肌缺血再灌注损伤的影响

Objective To investigate the effects of butorphanol pretreatment on myocardial ischemia-reperfusion (IR) injury in rats. Methods Forty healthy male SD rats weighing 200-250 g were randomly divided into 5 groups (n = 8 each) : sham operation group (group S); IR group; butorphanol pretreatment group (group B); Nor-BNI group (group N) and glibenclamide group (group G) . In group IR, B, N and G, myocardial IR was produced by occlusion of left anterior descending artery (LAD) for 30 min followed by 120 min reperfusion. In group S and IR, normal saline S ml/kg was injected via femoral vein 10 min before ischemia and then continuously infused at a rate of 5 ml· kg -1· h-1 iv. In group B, butorphanol 25 μg/kg was injected via femoral vein 10 min before ischemia and the rest method was the same as that described in group IR. In group N, Nor-BNI 2 mg/kg (a selective κ-opioid receptor antagonist) was injected via femoral vein 20 min before ischemia and the rest method was the same as that described in group B. In group G, glibenclamide 1 mg/kg (a KATP channel blocker) was injected via femoral vein 10 min before ischemia and the rest method was the same as that described in group B. Blood samples were taken from femoral artery at 120 min of reperfusion for determination of the concentrations of serum TNF-α, IL-6 and IL-10 by ELISA. Myocardial infarct area and ischemic area were measured by TTC staining and myocardial infarct size was calculated. Results The concentrations of serum TNF-a, IL-6 and IL-10 were significantly higher in the other four groups than in group S (P < 0.05) . The concentrations of serum TNF-α andIL-6 were significantly decreased while IL-10 increased, and the myocardial infarct size was significantly decreased in group B, N and G as compared with group IR ( P < 0.05) . The concentrations of serum TNF-α and IL-6 were significantly increased while the concentration of IL-10 decreased) and the myocardial infarct size was significantly increased in group N and G as compared with group B ( P < 0.05). Conclusion Butorphanol pretreatment can protect the myocardium against IR injury in rate via activating κ receptor and KATP channel.     

糖尿病患者医院感染的病原菌分布与耐药性研究

目的调查糖尿病患者发生医院感染部位、病原菌分布及其耐药性,为临床预防治疗提供基础。方法选取医院普外科2010年12月-2013年11月因需手术收治的235例2型糖尿病医院感染患者为研究对象,调查分析入选患者临床资料,统计感染部位分布、病原菌种类及其对常规抗菌药物的耐药性,采用Microsoft Excel 2007版软件对数据进行分析。结果 235例医院感染患者中呼吸道感染占40.0%、泌尿道感染占21.3%、消化道感染占19.1%、皮肤及软组织感染占12.8%、血液感染占6.8%;共分离鉴定256株病原菌,革兰阴性菌占50.4%、革兰阳性菌占35.2%和真菌占14.4%;革兰阴性菌对多数常用抗菌药物具有较高耐药性,对头孢哌酮/舒巴坦耐药率较低,为9.8%~16.7%;对美罗培南和亚胺培南耐药率为0~4.2%;革兰阳性菌对克林霉素、万古霉素、莫西沙星和呋喃妥因耐药率较低,为10.0%~31.0%;对替考拉宁和利奈唑胺耐药率均为0。结论糖尿病合并医院感染患者感染部位以呼吸道感染为主,病原菌以革兰阴性菌为主,其对大多数常用抗菌药物有较高的耐药率,临床应参考药敏试验结果,合理选用抗菌药物。     

沈阳市新诊断HIV感染者整合酶抑制剂原发耐药分析

目的明确沈阳市新诊断的HIV-1感染者整合酶抑制剂(integrase inhibitors, InIs)耐药株的传播情况。方法回顾性收集2018年6月至2019年3月沈阳市新诊断的HIV感染者80例,扩增血浆病毒RNA的整合酶编码基因,系统进化分析病毒基因型,以Stanford HIV耐药数据库解读耐药基因突变,计算原发耐药率并分析不同亚型毒株耐药相关自然多态性。结果 80例HIV-1感染者中共检出CRF01_AE感染者51例,占63.8%;CRF07_BC感染者14例,占17.5%,B亚型感染者6例,占7.5%;其他不典型重组9例,占11.3%。2例CRF01_AE感染者检出R263K突变,1例B亚型感染者检出E138A突变,总体耐药率为3.8%。CRF01_AE感染者在整合酶耐药相关位点50、74、119、153位氨基酸具有多态性,频率分别为5.9%、2.0%、13.7%和4.0%;而CRF07_BC感染者在整合酶耐药相关位点50、74、157位上氨基酸具有多态性,频率均为7.1%。结论沈阳市新诊断HIV感染者InIs原发耐药率较低,但部分感染者在HIV整合酶耐药相关位点具有氨基酸多态性。需要加强HIV整合酶耐药监测及对我国常见HIV流行株的耐药基因型和表型研究,更好地解读HIV整合酶耐药突变的意义。     

关于小儿支原体肺炎临床路径临床实施的总结、建议以及更深入的探讨

为贯彻卫生部下发的关于开展临床路径管理的相关规定,我们自2010年6月开始对住院的小儿支原体肺炎患儿实施临床路径的管理工作,并对此工作做出阶段性的总结,得出绝大多数病例(98.04%)可按临床路径顺利完成,极个别病例(1.96％)出现变异.对小儿支原体肺炎临床路径的修改与补充提出我们的建议,并对其更深入的探讨提出了我们的一些观点.     

弹性髓内钉与接骨板治疗儿童股骨中上段骨折的疗效比较

目的:探究弹性髓内钉与接骨板治疗儿童股骨干上段骨折的疗效对比.方法:回顾性分析自2010年1月至2012年12月在我院因股骨干上段骨折行切开复位内固定的患儿27例,自2012年10月至2016年12月在我院因股骨干上段骨折进行闭合复位弹性髓内钉内固定手术治疗的患儿38例,比较两组患者在手术时间、术中出血量、术中透视次数、住院时间、住院费用、并发症、骨折愈合时间的差异.结果:实验组与对照组在手术中手术时间、术中出血量、术中透视次数、住院时间方面差异显著,有统计学意义(P<0.05).两种方法住院费用、并发症、骨折愈合时间无明显差异.结论:弹性髓内钉对儿童股骨中上段骨折治疗在早期下地,减少并发症方面具有显著优势,所以临床中值得推广.     

基于计划行为理论的居民全谷物食品消费意愿影响因素分析

目的:探索山西省居民全谷物食品消费意愿的影响因素，为促进居民全谷物食品消费提出有效的干预措施提供理论基础。方法:基于计划行为理论，通过多阶段随机抽样与方便抽样相结合的方法，抽取1 125名山西省居民使用自编量表进行调查，利用结构方程模型分析居民全谷物食品消费意愿的影响因素。结果:探索性因子分析共提取到消费意愿、态度、主观规范、知觉行为控制4个公因子，累积解释方差率为66.729%。主观规范（β=0.569,P<0.001）和知觉行为控制（β=0.101,P<0.05）对消费意愿有正向影响；态度（β=0.072,P>0.05）对消费意愿影响不显著。结论:计划行为理论模型可以较好地解释居民全谷物食品消费意愿，主观规范和知觉行为控制是居民全谷物食品消费意愿的影响因素。     

硫代硫酸钠在血液透析患者难治性皮肤瘙痒症中的临床应用观察

目的探讨硫代硫酸钠在治疗血液透析患者难治性皮肤瘙痒症中的临床疗效。方法选取北京市海淀医院血液透析门诊规律透析患者,纳入经常规方法(包括局部外用药物疗法、中医中药、抗组胺药物、血液灌流、血液透析滤过)规律治疗6个月后仍有顽固皮肤瘙痒的46例患者。按随机数字表法分为对照组和观察组,各23例。对照组继续予常规方法治疗;观察组在常规治疗方法基础上加用硫代硫酸钠,比较两组患者的临床疗效,主要评价指标为治疗前后患者皮肤瘙痒评分情况及两组患者治疗8周后血肌酐、尿素氮、血钙、血磷、甲状旁腺激素等指标变化情况。结果观察组总有效率91.30%,明显高于对照组34.78%,差异有统计学意义(χ~2=15.769,P0.01);治疗后,观察组患者皮肤瘙痒评分较治疗前及对照组治疗后明显改善,差异有统计学意义(P0.01)。观察组中有1例患者用药后出现一过性注药侧肢体发凉症状;1例患者用药后胸闷,1分钟后自行缓解。结论硫代硫酸钠可有效缓解难治性尿毒症皮肤瘙痒,不良反应小,疗效显著。     

静脉注射骨髓基质细胞对局灶性脑缺血大鼠神经发生的影响

目的:观察经静脉移植骨髓基质细胞后局灶性脑缺血大鼠碱性成纤维细胞生长因子的表达,分析其对缺血性脑损伤神经发生的作用。方法:实验于2005-09/2006-05在中国医科大学实验动物中心完成。①取2月龄Wistar大鼠1只制备骨髓基质细胞,用第3～5代细胞制成单细胞悬液,浓度为3×109L-1。②选取健康成年Wistar大鼠36只,随机数字表法分为假手术组、模型对照组、细胞移植组,12只/组。模型对照组、细胞移植组大鼠建立大脑中动脉闭塞模型,假手术组手术步骤相同,但不阻塞大脑中动脉。术后大鼠提尾右前肢屈曲内收、向右侧转圈或向右侧倾倒为造模成功,每只造模大鼠均符合标准。③造模24h后,细胞移植组取3～5代骨髓基质细胞,消化离心后抽取1mL骨髓基质细胞悬液(浓度为3×109L-1)于鼠尾静脉输入。模型对照组、假手术组鼠尾静脉注射1mL生理盐水。④造模后14d,评估各组大鼠神经功能恢复情况。选择侧脑室室下区部位制作标本切片,免疫组化检测BrdU反应阳性细胞数及碱性成纤维细胞生长因子蛋白的表达。结果:各组大鼠全部进入结果分析。①术后各组大鼠神经功能损伤恢复评估:术后第14天,假手术组无神经功能缺损,细胞移植组神经功能损伤评分明显低于模型对照组[(3.2±0.84),(6.4±0.55)分,P<0.05]。②骨髓基质细胞BrdU免疫组化染色结果:细胞移植组大鼠侧脑室室下区BrdU免疫阳性细胞数明显高于模型对照组、假手术组[(43.1±12.7),(16.2±9.8),(15.6±9.1)个,P<0.05],模型对照组与假手术组差异无显著性意义(P>0.05)。③碱性成纤维细胞生长因子蛋白的表达:细胞移植组碱性成纤维细胞生长因子蛋白阳性率明显高于模型对照组、假手术组[(10.44±3.57),(3.92±1.42),(3.86±1.39)%,P<0.05],模型对照组与假手术组差异无显著性意义(P>0.05)。结论:静脉移植骨髓基质细胞可增强缺血性脑损伤神经发生,作用机制可能与上调脑内碱性成纤维细胞生长因子蛋白的表达水平有关。     

床边快速肌钙蛋白T定性检测在判断老年性心肌损伤中的应用

目的　运用床边快速肌钙蛋白 T( c Tn T)定性检测试纸条及血清心肌酶谱指标对 3 2例 60岁以上的老年性心肌损伤患者进行同步对照观察。方法　用床边快速 c Tn T定性检测试纸检测以 c Tn T在血中超过 0 .2 ng/ ml时 ,15 min内在测定区可出现色带为阳性结果作为标准 ,血清心肌酶谱指标采用反应温度为 3 7℃的酶动力学观察肌酸激酶 -同工酶 ( CK-MB)的水平。结果　 3 2例心肌损伤的患者均显示 c Tn T其敏感性 ,特异性均高于 CK-MB( P<0 .0 1) ,而且诊断时间延长较 CK-MB( P<0 .0 1)明显。结论　运用床边快速 c Tn T定性检测试纸条可以作为对症状不典型、心电图中无明显心肌损伤及梗死显示的疑似可能存在心肌微小损伤的老年患者早期诊断以及判断心肌损伤持续时间